How to Make a Total & Permanent Disability Claim

March 22, 2017

A permanent disability can completely change the way you live your life. You may suddenly find yourself in a difficult position with growing medical bills and reduced income due to physical limitations. The good news is that you may be eligible for compensation by submitting a Total and Permanent Disability claim.

What is Total & Permanent Disability?

A total and permanent disability claim is an insurance claim where generally you need to prove that you have suffered an injury or illness which will prevent you from returning to work permanently. Because every insurance policy is different, it is very important to first read and understand how total and permanent disability is defined in your insurance cover. There is no one definition.

When you find yourself in this position, make sure you are aware of all your financial options. Many people do not realise that they have access to insurance through their superannuation fund which may provide insurance to cover lost wages, lump sums on disability and medical expenses.

Requirements for Total & Permanent Disability

In most cases, it must be established that the injury is in fact permanent. . Even if your doctor tells you the damage is permanent days after the incident, you still may need to wait before you can claim total and permanent disability. Most total and permanent disability insurance has a minimum waiting period which varies between 3 months to 6 months. This means you will need to show you have been off work for that mimum waiting period because of your injury or illness. .

As noted above, every total and permanent disability insurance cover is different, you must understand your insurance cover. The most common forms of total and permanent disability insurance will cover you if you fit into one of the following:

You are unable to ever return to your ordinary work because of an injury or illness; or

You are unable to ever return to any form of work for which you are qualified by education, training or experience; or

If you have certain specified injuries, such as loss of an arm or leg or loss of sight; or

You are unable to ever again do normal household duties because of an injury or illness.

There are many different forms of total and permanent disability insurance cover. It is very important to find out what you are covered for, as that affects what evidence you will need to show in your claim.

Total & Permanent Disability Time Limits

Again different insurance policies have different time limits or no time limits. For example, the largest Queensland Superannuation fund, Sunsuper, changed its policy affecting all superannuation members with them. If you hold your superannuation with Sunsuper, then you must lodge a total and permanent disability claim with them within 5 years of your disablement otherwise you will not be eligible to claim.

Yet other superannuation funds like QSuper, BUSSQ or UniSuper do not have a time limit. If you hold private insurance, you need to check with your insurer or your broker.

There are also time limits on lodging a complaint with the Superannuation Complaints Tribunal, if you are unhappy with your Superannuation fund’s decision or their delay in making a decision. This time limit depends on whether you have ceased employment, the type of fund that you have the insurance with and the date of the decision or failure to make a decision. Generally, you must lodge your total and permanent disability claim within 2 years of ceasing work and then lodge a complaint with the Superannuation Complaints Tribunal within 4 years of a decision.

Alternatively, you can commence Court proceedings if you are not happy with the decision of the Superannuation fund or your insurer. If this happens, you have up to six year from the date of rejection start Court proceedings. Timing is essential to a successful outcome, so make sure you have everything in order and a record of the incident and all treatment and hardships experienced because of it. Doing so could mean the difference between not surviving and making a financial recovery.